A contractual agreement between the insurer and the provider in which covered members are encouraged to use specific health care providers in return for reduced rates is which type of arrangement?
a. Health maintenance organization
b. Preferred provider organization
c. Fee-for-service arrangement
d. Philanthropic agency
ANS: B
Correct: A preferred provider organization is an arrangement by which the member pays a premium for a fixed percentage of expense coverage. This method includes a required deductible and a copayment. The member may select a physician but pays less for physicians and facilities on the plan's preferred list.
Incorrect:
a. Health maintenance organizations (HMOs) require that the member pay a premium with a fixed copay and select a primary care physician approved by the HMO.
c. The fee-for-service arrangement is one in which the member pays a premium for a fixed percentage of covered expenses and is allowed to choose physicians and specialists without restraint.
d. A philanthropic agency provides care without fees, but the member does not select providers.
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